Word: treatments
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...doctors, is accomplished via a system of codes, which is already so complicated that there are special schools for it, granting degrees not just in coding but in special branches of coding. Coding boils down to assigning specific numbers to every problem (diagnosis codes) and other numbers to every treatment (treatment codes). Though the lists, in my field of orthopedics anyway, are woefully inadequate to capture how we actually think about or treat patients, they are still ponderous and complex. From common cold to brain tumor, open heart surgery to handing over an Ace bandage, there is a code that...
Though this tends to be the message, all too often the mechanism is much simpler. Computerized medicine means both more information - and less medicine. Less therapy, less surgery and less testing too. That's how it saves money. A variety of promising terms describe it - terms like targeted treatment, algorithmic patient-care, fiscally responsible medicine and evidence-based practice - but for doctors treating patients, one word describes how computerized records save money. Denial...
...blood count isn't high enough to "justify" the hospitalization for IV antibiotics, the physician whose judgment says "this patient is sick and belongs in the hospital" is told his services as well as the hospitalization will not be paid for. When a doctor is convinced a test or treatment is needed, (and his patient doesn't have the money to pay for it) he has just two choices: wait for the patient to get sick enough to "justify" what he wants, or join the game - and lie about how sick he is. It's just a matter of clicking...
Finally, the political debate also revolves around using information technology to figure out which treatments are most effective. This seems eminently sensible: might certain heart patients, for example, do just as well with clot-busting drugs as with more expensive angioplasty procedures? The drug route could save about $7000 a patient Crunching huge amounts of data from a wide cross section of patients could help us do better research than we are doing now. But what will happen when the new computerized research turns up a treatment that works a little better but costs much more? Will they tell...
...depressingly similar: the 10-year-old leukemia patient in Ohio who, after three rounds of chemotherapy and a bone-marrow transplant, had almost exhausted the maximum $1.5 million lifetime benefit allowed under her father's employer-provided plan; the Connecticut grocery-store worker who put off the radiation treatments for her Stage 2 breast cancer because she had used up her company plan's $20,000 annual maximum and was $18,000 in debt; the New Hampshire accountant who, unable to work during his treatment for Stage 3B stomach cancer, had to stop paying his mortgage to afford...